1902846603 NPI number — LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO. 1

Table of content: (NPI 1902846603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902846603 NPI number — LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO. 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO. 1
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LADY OF THE SEA MEDICAL CLINIC - CUT OFF
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902846603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
144 W 134TH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUT OFF
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70345-4128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-632-6233
Provider Business Mailing Address Fax Number:
985-632-7526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 W 134TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUT OFF
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70345-4128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-632-6233
Provider Business Practice Location Address Fax Number:
985-632-7526
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAFONT
Authorized Official First Name:
TAD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CHIEF CLINIC OFFICER
Authorized Official Telephone Number:
985-632-6401

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 193451 . This is a "MEDICARE PART A" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 5CJ01 . This is a "MEDICARE PART B" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1442861 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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